Is my child a finicky eater or is it something more serious?

It is completely normal to have food preferences. Everyone does! It makes sense that there are foods out there that we like more than others, and that we may want to eat those foods over ones we don’t like. Some people might have stronger food preferences than others and refer to themselves as a “picky eater” or “finicky eater.” Finicky eating is not always a problem, especially if you are able to adequately nourish yourself.

However, finicky eating can be a sign of something more serious. Maybe you have a general disinterest in food that prevents you from eating consistently or eating enough. Or maybe you’ve noticed a loved one cutting out foods or food groups for fear of eating them, citing heightened texture or flavor concerns. Often times in these cases no amount of bargaining or pursuading will be able to change their minds. These could be cases of “finicky eating” or “picky eating”. Or it could be something more serious.

What is Avoidant Restrictive Intake Disorder (ARFID)?

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder where individuals have highly selective eating habits that can lead to nutrition and energy deficiencies, and for children, failure to gain weight.Individuals with ARFID avoid or restrict foods due: sensory characteristics of food, fear of negative consequences, or apparent lack of interest in food/eating. The restrictive behavior of food is not driven by body image concerns or the desire to be thin, like other eating disorders. ARFID is not the same as being a finicky eater and should be treated as something more serious.

To support a finicky eater undergoing treatment for ARFID, it’s important to understand their diagnosis and what you can do to facilitate their healthy relationship with food.

1. ARFID is not the same as being a finicky eater

ARFID is a serious eating disorder, just like anorexia, bulimia, and binge eating disorder, which makes it different from being a finicky eater. ARFID is characterized by a continued failure to meet nutritional and/or energy needs and can cause severe deficiencies in calories (energy), macronutrients (think carbohydrates, fat, protein), and micronutrients (think vitamins and minerals). It requires swift and aggressive treatment to fix these nutritional imbalances.

2. ARFID looks different for each person

This is an eclectic eating disorder, meaning ARFID looks different for different people. It could look like:

• Avoiding food because of a fear of how it will make you feel afterward, such as having nausea or abdominal pain.
• Not eating enough due to a fear of choking or vomiting.
• Having a low appetite and general disinterest in/dislike of food.
• Avoiding foods based on certain sensory characteristics, such as texture or smell.

It is important to know that, in order for it to be ARFID, the feeding disturbance or food restriction cannot be due to another physical or mental illness. For example, not eating because you have the flu would NOT be considered ARFID.

3. ARFID can affect anyone

When many people think of ARFID, they think only of children and adolescents.  While it can be more frequently diagnosed in this age group, ARFID can affect people of all ages. It is possible that adults with ARFID went undiagnosed or untreated as children. ARFID also affects people of all genders, races, and socioeconomic backgrounds.

If you think you might have ARFID or another eating disorder, make an appointment with a licensed health professional that specializes in eating disorder treatment.

4. Those with ARFID are not motivated by weight loss

With ARFID, the inability to meet energy/nutritional needs is not due to concern about weight gain, desire for weight loss, or negative body image. In fact, many people with ARFID report wanting to gain weight to be bigger/stronger/healthier and more similar to their peers. However, while their food choices are not motivated by weight loss, someone with ARFID may still cite wanting to lose weight or change their body unrelated to their eating.

5. ARFID can impact growth and development

Those with ARFID often experience recent weight loss and/or poor growth and development. Usually, if your child is a finicky eater, they will maintain their weight or continue to follow their normal growth patterns. For children with ARFID, they may have fallen off their normal growth curve on a growth chart. Food avoidance and/or limited food intake can cause nutritional deficiencies. Examples of nutrients a patient may not have enough of are calcium, vitamin D, iron, and B vitamins.

6. ARFID can impact social functioning

ARFID can make social situations more challenging to navigate. Imagine if you couldn’t go to a friend’s house for fear they would serve foods you don’t eat due to their texture? Or if you avoided eating foods you loved because of how worried you feel afterward? It can be hard to go to parties, go out to eat, or simply have a normal family dinner. Those with ARFID may feel like they are missing out on life because of their avoidance of food and eating. Treatment is designed to help re-integrate social eating into an individual’s life in a safe and fun way.

7. Being a finicky eater doesn’t mean you have ARFID

Some people are naturally more selective with the foods they eat. Others are more adventurous eaters. This variation is very normal. Kids often are pickier eaters than adults but tend to grow out of that with consistent exposure to different foods. Just because someone is more selective with the foods they eat doesn’t mean they have ARFID. However, if avoidance of food or limited intake is negatively affecting physical health and/or psychological and social functioning, it is important to seek help from a trained professional to assess for ARFID (ie: therapist, dietitian, or psychiatrist).

8. ARFID treatment involves repeated food exposures

A food exposure is repeatedly exposing someone to a feared food (or stimulus or situation) in a systematic way to desensitize them. Oftentimes in treatment, the person with ARFID will make a list, with the help of a therapist or dietitian, of foods they have been avoiding for any reason and rank which foods are more anxiety-producing than others. The goal is to then try the foods on the list repeatedly, starting with those that cause the least worry. Once a new food has been introduced and tried successfully, it can be added to the individual’s normal diet. Did you know that it can take 10-12 times of trying a new food to know if you really like it? This is why repeated exposures are so important in treating ARFID.

9. Assemble a specialized treatment team for comprehensive support

People with ARFID do recover and go on to live very full and productive lives. They are able to expand the foods they eat and renegade in the social aspects of their lives. Just as with other eating disorders, a support network is key to treating ARFID. Finding a therapist, doctor and dietitian will help you along your recovery journey, while family/friends can assist with meal preparation, food exposures, and anxiety management. When looking for treatment providers, make sure to work with someone that specializes in treating eating disorders!

10. Working with a registered dietitian is essential to treatment success

When putting together a treatment team, finding a dietitian that specializes in eating disorders is essential. A dietitian can help to:

• Increase the amount of food eaten – When your nutrition needs are not being met, a dietitian can provide a meal plan to help increase calorie intake, starting with preferred food items at first, ie: food items that the individual with ARFID already feels comfortable eating.
• Increase the variety of foods eaten – A dietitian can help a patient to create lists of preferred foods, fear foods, and “willing to try” foods and work with them to do food exposures. 
• Monitor for proper growth and development – A dietitian can assess growth patterns, identify barriers to growth and development, and implement interventions to target those barriers.
• Provide nutrition education – A dietitian provides general nutrition education on the importance of macronutrients and micronutrients for overall health and key food sources of those nutrients. A dietitian can also make recommendations for dietary supplements if needed.